International Journal of General Medicine (Mar 2023)
Effects of Remote Ischemic Preconditioning on Postoperative Cognitive Dysfunction in Elderly Patients with Laparoscopic Cholecystectomy
Abstract
Mengnan Han,1,2 Xiaoqian Wu,1 Jianli Li,1 Shuang Han,1 Junfang Rong1 1Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, People’s Republic of China; 2Graduate Faculty, Hebei North University, Zhangjiakou, People’s Republic of ChinaCorrespondence: Jianli Li, Department of Anesthesiology, Hebei General Hospital, No. 348 West Heping Road, Shijiazhuang, 050051, People’s Republic of China, Tel +86 13785118676, Email [email protected]: We hypothesized that remote ischemic preconditioning (RIPC) could improve postoperative cognitive dysfunction (POCD) in elderly patients following laparoscopic cholecystectomy (LC).Patients and Methods: Eighty-eight patients were randomly assigned to either the control or the RIPC group. The RIPC was applied on the right upper limb using a blood pressure cuff inflating 200 mmHg, consisting of 3 cycles of 5 min ischemia and 5 min reperfusion. Serum concentrations of Neuron-specific Enolase (NSE) and Brain-Derived Neurotrophic Factor (BDNF) were collected at one-day preoperative (T0), at the end of the operation (T4) and one-day postoperative (T5). Z score was tested at T0 and 3 days after the operation (T6). POCD was determined if there were two Z scores ≥ 1.96 at the same time or an average Z score ≥ 1.96.Results: There was no significant difference in the Z score of each test between the two groups at T0 (P > 0.05). Notably, the duration of Stroop test C was significantly shorter in the RIPC group than that in the Control group at T6 (P = 0.01). POCD occurred in 1/44 (2.3%) patients in the RIPC group and 8/44 (18.2%) patients in the control group at T6 (P=0.035). In addition, serum NSE concentration was significantly decreased, but serum BDNF concentration was increased compared with the control group at T4 and T5 (P< 0.001).Conclusion: RIPC could reduce the incidence of POCD in elderly patients after laparoscopic cholecystectomy.Keywords: postoperative cognitive dysfunction, remote ischemic preconditioning, regional cerebral oxygen saturation, elderly patients
